Comparative Efficacy Of Pitavastatin And Simvastatin In Patients With Hypercholesterolaemia

Comparative efficacy of pitavastatin and simvastatin in patients with hypercholesterolaemia:a meta-analysis of randomized controlled clinical trials English AbstractBackground:Simvastatin is a statin used to lower low-density ipoprotein cholesterol, but has limitations in patients on complicated regimens due to concerns about drug-drug interactions. Pitavastatin is a newly developed statin with limited drug-drug interactions. We conducted a meta-analysis to compare the clinical efficacy of simvastatin and pitavastatin in the control of hypercholesterolemia.Methods:Randomized clinical trials comparing the efficacy of pitavastatin and simvastatin were identified by searching PubMed (2000-2014) and EMBASE (2000-2014). The primary outcome subjected to meta-analysis was percent change in low-density lipoprotein cholesterol compared with baseline. The second outcomes subjected to meta-analysis was percent changes in total cholesterol (TC), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C) compared with baseline.Results:Four clinical trials were selected for meta-analysis. A total of908patients treated with pitavastatin (2or4mg/day) and381patients treated with simvastatin (20or40mg/day) were included in the final statistical analysis. No statistically significant difference was identified between treatment with pitavastatin4mg/day and treatment with simvastatin40mg/day for12weeks (mean difference-0.66;95%confidence interval-2.92,1.61; P=0.57). Similarly, no statistically significant difference was observed between pitavastatin2mg/day and simvastatin20mg/day for4weeks (mean difference-2.19;95%confidence interval-0.11,4.49; P=0.06). Treatment with pitavastatin was noninferior to simvastatin in all of the secondary outcomes and the safety profile was similar between the two statins.Conclusion:1. Pitavastatin is noninferior to simvastatin in lowering low-density lipoprotein cholesterol.2. Pitavastatin is similar with simvastatin in all of the secondary outcomes.3. Long-term treatment of pitavastatin has shown a favorable safety and tolerability. Objective:This study evaluates the prognostic significance and identifies risk factors for syncope and,clinical findings in hypertrophic cardiomyopathy (HCM) in a tertiary referral institution.Methods:A cohort of440consecutive patients with hypertrophic cardiomyopathy (HCM) from our center were enrolled from January2006and December2012. All patients were divided into two groups according to whether or not to have syncope history:group A syncope(n=37), groupB without syncope(n=403).The clinical characteristics, echocardiographic diagnosis and prognosis of the two groups were compared, by multivariate logstic regression to discuss the relationship among multiple parameters and syncope.Results:Compared with without group A, amaurosis/dizziness,cardiac murmur(located in apical region of heart and left border of sternum) and family history of HCM-sudden death were more frequent in group B(P<0.05).Meanwhile, syncope group HCM patients were younger than without syncope group HCM patients (P=0.001).Of the16patients who had sustained VT (sustained ventricular tachycardia) or ventricular fibrillation,5(12.5%) was documented in HCM patients with syncope,equally,ventricular arrhythmias were present in eleven out of11(2.4%) of the patients without syncope,differences achieved statistical significance (P=0.001). Of the37patients who had syncope,28(84.8) had premature ventricular contractions(PVCs). Meanwhile, PVCs was present in236out of258(91.5%) of the patients without syncope. This difference did not achieve statistical significance (P=0.83).However, sinus tachycardia between two groups obtained statistical significance(P=0.005).Similarly, Non-sustained ventricular tachycardia(NSVT), on Holter monitoring also has no significant difference between the two groups (P=0.48).Further, in univariate Logistic regression analysis, sustained VT/ventricular fibrillation were significantly related to the syncope(OR=5.933,95%confidence interval [CI]1.689-20.849, P=0.005). However, During follow-up, there is no significant difference in the incidence of clinically relevantevents for the two groups of patients (P>0.05).Forward Stepwise logistic analysis identified that sustained VT/ventricular fibrillation(OR=5.933,95%CI1.689-20.849, P=0.005) was a significant independent predictor of syncope in Hypertrophic Cardiomyopathy.Conclusion:1.Sustained VT/ventricular fibrillation is the main cause of syncope in Hypertrophic Cardiomyopathy.2.Syncope occurs more in young patients,who need active treatments.3.Further studies are needed to syncope mechanism. Objective:To evaluate the clinical characteristics of non-sustained ventricular tachycardia(NSVT) during Holter monitoring in hypertrophic cardiomyopathy patients, and to further investigate the occurrence risk factors and prognosis prediction.Methods:A total of290patients with HCM were assessed in our hospital between2006and2012. All underwent ambulatory electrocardiogram monitoring.According to the records of NSVT, the patients were divided into two groups:NSVT group (group A, n=54) and Non-NSVT group (group B, n=236). Comparison of clinical manifestations, ECG parameters, Holterindex, ultrasound image characteristics. Beckoning two groups of patients,follow-up results and prognosis, and to further explore the effect of the relationship between clinical index and the occurrence of NSVT on prognosis.Results:This study included290HCM patients, including172cases accepted follow-up (59.3%), the mean follow-up time (1373.2+620.1) days.The results showed, the number of readmissions in NSVT group (0.89+2.1) was significantly higher than group Non-NSVT (0.34+1.1)(P=0.01). During follow-up,9patients (3.2%) died, the cause of death is unknown, including2cases of NSVT patients(4.1%),7Non-NSVT patients (3%), the difference was not significant between the two groups (P>0.05). Further multivariate logistic regression analysis showed that, B blood type and left atrial enlargement (LAD) are independent predictor risk facters in patients with HCM NSVT (OR=2.751,95%confidence interval1.115～6.786, P=0.028; OR=0.703,95%confidence interval1.071～3.813, P=0.03). In addition, discovery of apical hypertrophic cardiomyo-pathy occurs less frequently in NSVT (P=0.002).Conclusion:The first discovered,blood type B, LAD enlargementwere independent determinants of HCM occurring in patients with NSVT.(2) NSVT can aggravate the symptoms and signs of patients with HCM, prolonged hospitalization, and can increase the number of readmissions and the economic burden.(3) Less NSVT occurred in the patients with type apical hypertrophic cardiomyopathy.